Challenging the Surgical Axiom: Albumin Level Does Not Reliably Predict Development of Wound Complications in Patients Undergoing Body Contouring.
CONCLUSION: Albumin values were not associated with wound complications or need for reoperation in patients undergoing body contouring. Further research is warranted. PMID: 32097112 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Evolving Treatment of Frontal Sinus Cholesteatoma: A Case Report.
DISCUSSION: The pathogenesis of frontal sinus cholesteatoma varies based on its cause (congenital vs acquired). Clinical diagnosis remains challenging but is aided by nasal endoscopy, computed tomography, and magnetic resonance imaging. Historically, FSC has been managed by total extirpation through open approaches, which can entail substantial morbidity. With sophisticated endoscopic sinus instrumentation and image guidance, FSC can be successfully treated via an endoscopic approach. Serial débridements and washouts in an outpatient setting may adequately manage the residual disease in the postoperative period. ...
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Primary Breast Carcinoma of the Vulva Metastatic to Lymph Nodes and Bones: A Case Report and Literature Review.
DISCUSSION: For a diagnosis of primary breast cancer of the vulva, a thorough metastatic workup should be performed, with attention directed toward detecting a breast primary disease by results of the history, physical examination, and radiologic examination of the breasts mainly to help confirm that the vulvar lesion is the primary site as opposed to metastasis from a breast primary cancer and also for staging. Management of this rare entity is challenging because of a lack of specific guidelines, and treatment, therefore, is similar to that of breast cancer.Treatment should consist of an individualized combination of sur...
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Prostate Cancer and Asbestos: A Systematic Review and Meta-Analysis.
CONCLUSION: Patients who were exposed to asbestos should possibly be encouraged to complete more frequent prostate cancer screening. PMID: 32097115 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Immunotherapy Outcomes in Advanced Melanoma in Relation to Age.
CONCLUSION: Aging does not seem to affect response to checkpoint inhibitors. Elderly patients with metastatic melanoma should be treated similarly to younger patients. PMID: 32097116 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Effects on Medical Students of Longitudinal Small-Group Learning about Breaking Bad News.
CONCLUSION: The activities offered helped students develop communication skills. They made connections between their formal training (communication and cognitive skills) and actual clinical practice in a community-based rotation. The knowledge and skills acquired gave them tools needed to deliver bad news in their future clinical practice. PMID: 32097117 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

MD Aware: A Mindful Medical Practice Course Guide.
Authors: Dobkin PL PMID: 32097118 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - February 26, 2020 Category: General Medicine Tags: Perm J Source Type: research

Adverse Childhood Experiences (ACEs) and Community Physicians: What We've Learned.
Authors: Stork BR, Akselberg NJ, Qin Y, Miller DC Abstract INTRODUCTION: The prevalence of childhood trauma, as measured by the Adverse Childhood Experiences (ACE) Study questionnaire, has been studied in a wide variety of community settings. However, little is known about physicians' familiarity with and use of the ACE questionnaire or the prevalence of childhood trauma in the physician community. OBJECTIVE: To survey a convenience sample of community-based physicians and resident physicians to assess for familiarity with and use of the ACE questionnaire in clinical practice and to measure the prevalence of th...
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Association Between Peripheral Blood Oxygen Saturation (SpO2)/Fraction of Inspired Oxygen (FiO2) Ratio Time at Risk and Hospital Mortality in Mechanically Ventilated Patients.
CONCLUSION: The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification using electronic health record data in ventilated patients. PMID: 32069205 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Mixed Serous and Clear Cell Adenocarcinoma of the Ovary Presenting with Symptomatic Hypercalcemia: A Case Report and Clinical Considerations.
DISCUSSION: Hypercalcemia is a rare but possible primary presenting symptom of ovarian cancer. In these patients, serum calcium measurements could possibly serve as a tumor marker for disease. PMID: 32069206 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Identifying Patients with Rare Disease Using Electronic Health Record Data: The Kaiser Permanente Southern California Membranous Nephropathy Cohort.
DISCUSSION: Our findings suggest that ICD-9 diagnosis codes might be a convenient tool to identify patients with MN using EHR and/or administrative claims information. Codes selected from supervised learning achieved better overall performance, suggesting the potential of developing data-driven methods. PMID: 32069207 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

A Novel Instrument for Integrated Measurement and Assessment of Intrinsic Motivation, Team Climate, and Burnout in Multidisciplinary Teams.
CONCLUSION: The study fills a gap in the health services research literature pertaining to the performance of multidisciplinary teams. PMID: 32069208 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Negative-Pressure Wound Therapy to Reduce Wound Complications after Abdominoperineal Resection.
DISCUSSION: Additional, prospective research is needed to confirm the benefit of prophylactic incisional NPWT. PMID: 32069209 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Haiku and Healing-Creating Connections.
Authors: Stork B PMID: 32069210 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Novel use of Apple Watch 4 to Obtain 3-lead Electrocardiogram and Detect Cardiac Ischemia.
Authors: Gil MÁC PMID: 32069211 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Awareness of Heterotopic Ossification in Total Joint Arthroplasty: A Primer.
Authors: Lespasio MJ, Guarino AJ Abstract Heterotopic ossification (HO) is the presence of normal bone in soft tissue where bone should not exist. After direct musculoskeletal trauma of the surrounding soft tissue, HO is hypothesized to develop from a dysfunction of normal lamellar bone formation and remodeling that appears in nonskeletal areas of the body. Acquired HO related to total joint arthroplasty (TJA) of the hip and knee forms outside the joint capsule and can be a challenging condition when it impairs the essential healing process after elective surgery. Although HO is rare after elective TJA and thus cli...
Source: The Permanente journal - February 20, 2020 Category: General Medicine Tags: Perm J Source Type: research

Novel Antiplatelet Perioperative Bridging Protocol for Lung Lobectomy: A Case Report.
We describe the novel addition of ticagrelor (a short-acting oral antiplatelet agent) to eptifibatide (a short-acting intravenous antiplatelet agent) to bridge DAPT for surgery. DISCUSSION: This ticagrelor-eptifibatide perioperative bridge resulted in decreased preoperative hospitalization compared with eptifibatide alone. There were no associated perioperative cardiac or bleeding complications. PMID: 31926566 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Minimally Invasive Repair of Pediatric Morgagni Hernias Using Transfascial Sutures with Extracorporeal Knot Tying.
CONCLUSION: Morgagni hernias are amenable to minimally invasive repair with this simple technique. With large defects, synthetic patches should be used. Recurrences are rare, and morbidity is low. PMID: 31926567 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

A 10-Year Analysis of 3693 Craniotomies during a Transition to Multidisciplinary Teams, Protocols, and Pathways.
CONCLUSION: Multidisciplinary teams, protocols, and pathways reduced craniotomy complication rates, improved hospital length of stay by 63%, reduced costs, and increased professional collegiality and satisfaction. A searchable craniotomy discharge summary is an important tool for continuous monitoring of quality and efficiency of care. PMID: 31926568 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Abdominal Aortic Aneurysm: A Case Report and Literature Review.
DISCUSSION: A literature review of proper screening, referral timeframe, the most common surgical techniques, potential complications, and postoperative surveillance was conducted. Early detection, referral to vascular surgery, and possible open or endovascular repair are key to limiting the morbidity and mortality associated with AAA. PMID: 31926569 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Periodontal Diseases and Age-Related Macular Degeneration: Is There a Link? A Review.
CONCLUSION: According to the studies included in this review, periodontal disease may be a plausible risk factor for AMD and may have a potential role in the earlier stages of this eye disease. Further studies should be encouraged for better understanding of this potential new relationship. PMID: 31926570 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Spontaneous Coronary Artery Dissection: Clinical Characteristics, Management, and Outcomes in a Racially and Ethnically Diverse Community-Based Cohort.
CONCLUSION: The study cohort is comparable to published SCAD cohorts, but notable for a racially and ethnically diverse population. Compared with the controls, only pregnancy and hyperlipidemia were associated with SCAD. For the SCAD cases, major adverse cardiovascular events occurred in 8.1%, and race did not influence outcomes. PMID: 31926571 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

911 Emergency. What Is Your Emergency and Location? My Road to Mindfulness.
Authors: La Borie P PMID: 31926572 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Poststreptococcal Reactive Arthritis: Diagnostic Challenges.
Authors: Chun C, Kingsbury DJ Abstract Poststreptococcal reactive arthritis (PSRA) is associated with prior group A β-hemolytic streptococcal infection and has a reported annual incidence of 1 to 2 cases per 100,000 persons, approximately twice that of acute rheumatic fever (ARF) in the US. Children who present with reactive arthritis are not uncommon in a busy general pediatric practice in the US, whereas children who present with ARF are very rare. Distinguishing PSRA from ARF can be challenging because the symptoms and signs are similar, but the diseases differ in long-term therapy, follow-up evaluation, an...
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Association of Type and Frequency of Postsurgery Care with Revision Surgery after Total Joint Replacement.
CONCLUSION: Future studies are needed to determine if more specific data on reasons for the higher frequency of outpatient visits can refine these findings and elicit more specific recommendations for TJA devices. PMID: 31926574 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Predictive Factors for Early Relapse in Multiple Myeloma after Autologous Hematopoietic Stem Cell Transplant.
Authors: Pourmoussa AM, Spielberger R, Cai J, Khoshbin O, Farol L, Cao T, Sahebi F Abstract INTRODUCTION: Despite advances in therapy for multiple myeloma, patients have continued to experience relapse. We sought to better understand this. OBJECTIVE: To identify factors that predict early relapse in patients with multiple myeloma who receive autologous hematopoietic peripheral stem cell transplant (HSCT). METHODS: Retrospective analysis of Kaiser Permanente Southern California patients who received HSCTs between 2008 and 2012. RESULTS: A total of 141 patients were included. Factors found to be associate...
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Health Literacy among Individuals with Disabilities: A Health Information National Trends Survey Analysis.
CONCLUSION: Precise assessment of health literacy and disabilities is necessary to identify and address the unique concerns of this population. PMID: 31926576 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

ECG Diagnosis: Brugada Syndrome.
Authors: Othieno AA, Isaacs DJ, Vinson DR, Levis JT PMID: 31926577 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 14, 2020 Category: General Medicine Tags: Perm J Source Type: research

Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystitis.
Authors: Guo RF, Nguyen DL, Park S, Nguyen K, Ko S, Chiu VY, Dickter J, Becker D, Cho P Abstract CONTEXT: Current guidelines recommend a nonfluoroquinolone agent as first-line treatment of acute uncomplicated cystitis (AUC) because of concerns of antimicrobial resistance and adverse effects. OBJECTIVE: To test whether a multifaceted intervention involving education and feedback reduced primary care practitioners' ciprofloxacin prescriptions for AUC therapy. DESIGN: Primary care practitioners at 3 medical offices participated: 65 in the intervention group and 51 in the control group. Intervention group parti...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Lifestyle Medicine: The Role of the Physicial Therapist.
Authors: Worman RS PMID: 31905332 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Refining the Definition of Polypharmacy and Its Link to Disability in Older Adults: Conceptualizing Necessary Polypharmacy, Unnecessary Polypharmacy, and Polypharmacy of Unclear Benefit.
Authors: Lee EA, Brettler JW, Kanter MH, Steinberg SG, Khang P, Distasio CC, Martin J, Dreskin M, Thompson NH, Cotter TM, Thai K, Yasumura L, Gibbs NE Abstract The term polypharmacy in older adults is generally used in a pejorative context in the medical literature. Because of its link to geriatric syndromes and disability, the avoidance of polypharmacy is usually recommended in older adults as a strategy to optimize functional status. However, there are many polypharmacy regimens based on high-quality trials that clearly reduce the risk of disability in older adults. Other guidelines for older adults recommend the...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Adverse Childhood Experiences, Other Psychosocial Sources of Adversity, and Quality of Life in Vulnerable Primary Care Patients.
CONCLUSION: This disadvantaged primary care population had high numbers of ACEs. ACEs correlated with increasing numbers of health problems and worse QOL. Enhanced awareness and action are needed to reduce health disparities and improve outcomes in similar populations. PMID: 31905334 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Outcomes of Robotic Hysterectomy for Treatment of Benign Conditions: Influence of Patient Complexity.
Authors: Herrinton LJ, Raine-Bennett T, Liu L, Alexeeff SE, Ramos W, Suh-Burgmann B Abstract INTRODUCTION: Robotic hysterectomy may offer advantages for complex cases over the conventional laparoscopic approach. OBJECTIVE: To assess the association of surgical approach (robotic vs conventional) with blood loss, risks of readmission, reoperation, complications, and average operative time. METHODS: In a retrospective cohort study, we used the electronic medical records of Kaiser Permanente Northern California, 2011 to 2015, to estimate outcomes of robotic and conventional laparoscopic hysterectomy among women...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Important Considerations for Design and Implementation of Decision Aids for Shared Medical Decision Making.
CONCLUSION: Decision aids can be a valuable tool for shared medical decision making. Their quality and usefulness can be maximized by involving users in their creation and by attending to key considerations in their design, implementation, and appraisal. PMID: 31905336 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

CRcoder: An Interactive Web Application and SAS Macro to Support Personalized Clinical Decisions.
CONCLUSION: This user-friendly software performs the advanced statistical analyses needed to estimate typical and personalized concurrent risks. PMID: 31905337 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Learning in Humans versus Hierarchies.
Authors: Emberton M Abstract Organizations worldwide as well as scholars in business, psychology, medicine, and the social sciences are racing to identify the rules that drive organizational innovation vs status quo, the rules that drive employee engagement vs oppression, and the rules that drive effective leadership vs micromanagement. This phenomenon is burgeoning because relying on instinctive leadership alone leaves organizations susceptible to the possibility of ineffectual leadership in their hierarchies. To identify these rules, we first need to connect the patterns of how humans learn and solve problems and...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Ceftriaxone-Induced Hemolytic Anemia: A Rare Case Report.
We report a case of ceftriaxone-induced immune hemolytic anemia in a 62-year-old woman who had a negative result of a direct antiglobulin test. DISCUSSION: A review of the literature highlights the salient features of DIIHA and underscores the importance of keeping the suspicion of DIIHA high in the relevant clinical settings because ceftriaxone has been associated with particularly severe outcomes of DIIHA. In cases of unclear hemolysis and despite a negative result of a direct antiglobulin test, the treating physician must keep suspicion of DIIHA high and meticulously look for the possible culprit drugs. Treatment wi...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

The Sword of Damocles: Living with Neurofibromatosis Type 1.
Authors: Botero-Meneses JS Abstract Both as a physician and as a patient, having neurofibromatosis type 1 has been an important part of my life. In my practice as a physician and as a professor, I have tried to reflect on the reality of living with a genetic condition and how it affects the way I live and practice medicine. PMID: 31905340 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Aspirin Use, Compliance, and Knowledge of Anticancer Effect in the Community.
Authors: Ranger GS, McKinley-Brown C, Rogerson E, Schimp-Manuel K Abstract INTRODUCTION: Millions of adults worldwide use low-dose aspirin for secondary prevention of heart disease. Results of randomized trials indicate that regular use of low-dose aspirin may reduce the risk of colorectal cancer by more than 20%, leading to speculation of its chemoprevention role for high-risk groups. Little is known, however, about the use of aspirin in our community. OBJECTIVE: To determine aspirin use and therapy compliance (never or rarely missing a dose) and to assess whether patients in our community are aware of its ant...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Importance of Assessing Compliance with Conservative Treatment of Primary Hyperoxaluria Type 1: A Case Report of a Patient with I244T/c.969-3C > G Mutation.
We describe a 5-month-old asymptomatic female patient with bilateral diffuse nephrocalcinosis and nephrolithiasis. Laboratory and genetic findings confirmed PH1. She was promptly administered conservative treatment consisting of high fluid intake, calcium oxalate crystallization inhibitors, and pyridoxine. Nephrocalcinosis and urolithiasis disappeared after 2 years of treatment. As far as we know, this is a unique case of a patient with an I244T/null mutation diagnosed after the neonatal period and with normal renal function, who remained asymptomatic during an 18-year follow-up. This case is also unique because of the lon...
Source: The Permanente journal - January 7, 2020 Category: General Medicine Tags: Perm J Source Type: research

Reducing Workplace Absenteeism Caused by Work Stress in a Health Maintenance Organization Department of Psychiatry.
DISCUSSION: This is the first known treatment program from a health maintenance organization to provide data on return-to-work outcomes. By providing specialty mental health treatment and getting patients back to work more quickly, this program has potential to reduce mental health service utilization. These results show promise for program expansion and have broader implications for health care organizations and employers. PMID: 31852041 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Narrative Approaches to North American Indigenous People Who Attempt Suicide.
CONCLUSION: A narrative approach to indigenous people who attempt suicide is compatible with indigenous culture and appears to be successful. PMID: 31852042 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

"Not Until I See My Other Doctor".
"Not Until I See My Other Doctor". Perm J. 2019;24: Authors: Bair H Abstract This story is based on a series of encounters between the author-a medical student-and a hospitalized patient with terminal cancer. Over multiple conversations, the narrator becomes closely acquainted with the patient's life and outlook, and helps her navigate an important decision regarding the course of her treatment. In the process, the narrator is given the opportunity to examine the limits of medicine and what matters to patients at the end of life. PMID: 31852043 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Effectiveness of Best Practice Alerts for Potentially Inappropriate Medication Orders in Older Adults in the Ambulatory Setting.
CONCLUSION: No association was identified between PIM dispensing after a prescriber was alerted with a BPA and reduced rates of falls/fractures/injuries and cognitive impairment. PMID: 31852044 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Trauma-Informed Care in Pediatrics: A Developmental Perspective in Twelve Cases with Narratives.
CONCLUSION: When pediatric practitioners discover, intervene, and address the adverse effects of ACEs, their care becomes more efficacious and evidence based. PMID: 31852045 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Health Care Practitioners and Families Writing Together: The Three-Minute Mental Makeover.
Authors: Thoele DG, Gunalp C, Baran D, Harris J, Moss D, Donovan R, Li Y, Getz MA Abstract INTRODUCTION: Expressive writing, the process of self-expression through writing, appears to have beneficial effects. Our hospital's narrative medicine group developed an expressive writing tool, the Three-Minute Mental Makeover (3MMM). OBJECTIVE: To evaluate the effectiveness of the 3MMM to reduce stress and optimize communication between health care practitioners and their patients/families. METHODS: Patients and families were recruited from a Chicago-area children's hospital from December 2016 through July 2017, fr...
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Don't Fall for That: A Residency Curricular Innovation about Fall Prevention.
CONCLUSION: Fall prevention remains an important yet undertaught topic for trainees and practicing physicians. These brief multicomponent workshops can be easily implemented and adapted for all clinical learners. PMID: 31852047 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage.
CONCLUSION: Together, these results suggest that MA plans may have not only higher caseloads but also a more costly case mix of beneficiaries with certain diseases than historically was the case. Our findings can help inform MA plans to understand their beneficiaries' disease burden and prepare for provision of relevant services. PMID: 31852048 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Confusion vs Broca Aphasia: A Case Report.
We present a case of Broca aphasia that was initially interpreted as confusion. CASE PRESENTATION: A 76-year-old woman was brought to the Emergency Department because of confusion and slurred speech that began in the morning. The patient had an extensive history of alcohol abuse, hyperlipidemia, and hypertension and had recently quit drinking 5 days earlier. The patient appeared confused, answering questions with "I don't know," but had no signs of agitation. Magnetic resonance imaging of the brain confirmed a recent infarct involving the left frontal and occipital lobes, coinciding with the Broca area. The p...
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research

Multiples of Median Income: A Tool to Call out Drugs that are High Cost and Low Value.
Authors: Kottke TE, Zinkel AR, Fazio CJ Abstract As currently priced, many medications are harming society because they are high cost and low value, and they divert resources from interventions that could promote the health and well-being of Americans to a much greater extent. We believe that cost-effectiveness, stated as dollars per quality-adjusted life-year, is not meaningful for many Americans. By contrast, a measure indexed to household income would be far more salient. We therefore propose reporting the costs of drugs and medical devices as multiples of median income of US households. Although this simple cha...
Source: The Permanente journal - December 21, 2019 Category: General Medicine Tags: Perm J Source Type: research